Background: People with aphasia often struggle with verbal hospital meal-ordering systems, which can reduce autonomy, engagement, and food choice satisfaction. Picture-based menus may support autonomous food ordering for people with language difficulties.
Aim: To evaluate the impact of an aphasia-friendly picture-based hospital menu compared with the standard hospital ordering process.
Methods: This mixed-methods, before-and-after study compared a traditional verbal ordering process with an aphasia-friendly picture-based iPad menu. Twelve adults with aphasia in inpatient rehabilitation at Flinders Medical Centre Rehabilitation, Aged Care, and Palliative Care sector, each completed three observations using the standard verbal system and three using the pictorial menu. Oral intake, ease of ordering, and ordering time were recorded. Participants rated menu preference and satisfaction using pictorial response formats, and family/carers provided brief qualitative feedback.
Results: Mean oral intake was comparable between conditions (6337 kJ/73 g protein vs. 6303 kJ/68 g protein), indicating that the pictorial menu did not reduce nutritional intake. Eighty-three per cent preferred the pictorial menu, reporting greater ease of use, reduced cognitive load, and enhanced autonomy. Ordering times showed variability, with most participants demonstrating a learning effect and improved efficiency over time. Qualitative analysis identified four themes: enhanced engagement and autonomy, improved comprehension and accuracy of food choices, mixed experiences with fatigue and interface navigation, and the need for accurate alignment between images and served meals.
Conclusion: This pilot demonstrates that an aphasia-friendly pictorial iPad menu is a feasible and highly acceptable alternative to traditional verbal meal ordering in stroke rehabilitation